CONTEXT: Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder. OBJECTIVE: To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder. DESIGN: We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation. SETTING: Outpatient and inpatient units at 3 university centers. PARTICIPANTS: A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141). MAIN OUTCOME MEASURES: Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts. RESULTS: Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatient psychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt. CONCLUSIONS: Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.
CONTEXT: Individuals with early onset of bipolar disorder are at high risk for suicide. Yet, no study to date has examined factors associated with prospective risk for suicide attempts among youth with bipolar disorder. OBJECTIVE: To examine past, intake, and follow-up predictors of prospectively observed suicide attempts among youth with bipolar disorder. DESIGN: We interviewed subjects, on average, every 9 months over a mean of 5 years using the Longitudinal Interval Follow-up Evaluation. SETTING:Outpatient and inpatient units at 3 university centers. PARTICIPANTS: A total of 413 youths (mean [SD] age, 12.6 [3.3] years) who received a diagnosis of bipolar I disorder (n=244), bipolar II disorder (n=28), or bipolar disorder not otherwise specified (n=141). MAIN OUTCOME MEASURES: Suicide attempt over prospective follow-up and past, intake, and follow-up predictors of suicide attempts. RESULTS: Of the 413 youths with bipolar disorder, 76 (18%) made at least 1 suicide attempt within 5 years of study intake; of these, 31 (8% of the entire sample and 41% of attempters) made multiple attempts. Girls had higher rates of attempts than did boys, but rates were similar for bipolar subtypes. The most potent past and intake predictors of prospectively examined suicide attempts included severity of depressive episode at study intake and family history of depression. Follow-up data were aggregated over 8-week intervals; greater number of weeks spent with threshold depression, substance use disorder, and mixed mood symptoms and greater number of weeks spent receiving outpatientpsychosocial services in the preceding 8-week period predicted greater likelihood of a suicide attempt. CONCLUSIONS: Early-onset bipolar disorder is associated with high rates of suicide attempts. Factors such as intake depressive severity and family history of depression should be considered in the assessment of suicide risk among youth with bipolar disorder. Persistent depression, mixed presentations, and active substance use disorder signal imminent risk for suicidal behavior in this population.
Authors: Thomas E Joiner; Yeates Conwell; Kathleen Kara Fitzpatrick; Tracy K Witte; Norman B Schmidt; Marcelo T Berlim; Marcelo P A Fleck; M David Rudd Journal: J Abnorm Psychol Date: 2005-05
Authors: Hanga Galfalvy; Maria A Oquendo; Juan J Carballo; Leo Sher; Michael F Grunebaum; Ainsley Burke; J John Mann Journal: Bipolar Disord Date: 2006-10 Impact factor: 6.744
Authors: Christianne Esposito-Smythers; Tina Goldstein; Boris Birmaher; Benjamin Goldstein; Jeffrey Hunt; Neal Ryan; David Axelson; Michael Strober; Mary Kay Gill; Andrea Hanley; Martin Keller Journal: J Affect Disord Date: 2010-01-22 Impact factor: 4.839
Authors: Boris Birmaher; David Axelson; Benjamin Goldstein; Michael Strober; Mary Kay Gill; Jeffrey Hunt; Patricia Houck; Wonho Ha; Satish Iyengar; Eunice Kim; Shirley Yen; Heather Hower; Christianne Esposito-Smythers; Tina Goldstein; Neal Ryan; Martin Keller Journal: Am J Psychiatry Date: 2009-05-15 Impact factor: 18.112
Authors: Gabriele S Leverich; Lori L Altshuler; Mark A Frye; Trisha Suppes; Paul E Keck; Susan L McElroy; Kirk D Denicoff; Gabriela Obrocea; Willem A Nolen; Ralph Kupka; Jörg Walden; Heinz Grunze; Sara Perez; David A Luckenbaugh; Robert M Post Journal: J Clin Psychiatry Date: 2003-05 Impact factor: 4.384
Authors: Diana Khoubaeva; Mikaela Dimick; Vanessa H Timmins; Lisa M Fiksenbaum; Rachel H B Mitchell; Ayal Schaffer; Mark Sinyor; Benjamin I Goldstein Journal: Eur Child Adolesc Psychiatry Date: 2021-05-24 Impact factor: 4.785
Authors: Danella M Hafeman; Brian Rooks; John Merranko; Fangzi Liao; Mary Kay Gill; Tina R Goldstein; Rasim Diler; Neal Ryan; Benjamin I Goldstein; David A Axelson; Michael Strober; Martin Keller; Jeffrey Hunt; Heather Hower; Lauren M Weinstock; Shirley Yen; Boris Birmaher Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-07-29 Impact factor: 8.829
Authors: Ayal Schaffer; Erkki T Isometsä; Jean-Michel Azorin; Frederick Cassidy; Tina Goldstein; Zoltán Rihmer; Mark Sinyor; Leonardo Tondo; Doris H Moreno; Gustavo Turecki; Catherine Reis; Lars Vedel Kessing; Kyooseob Ha; Abraham Weizman; Annette Beautrais; Yuan-Hwa Chou; Nancy Diazgranados; Anthony J Levitt; Carlos A Zarate; Lakshmi Yatham Journal: Aust N Z J Psychiatry Date: 2015-07-14 Impact factor: 5.744
Authors: Tina R Goldstein; Megan Krantz; John Merranko; Matthew Garcia; Loren Sobel; Carlos Rodriguez; Antoine Douaihy; David Axelson; Boris Birmaher Journal: J Child Adolesc Psychopharmacol Date: 2016-07-15 Impact factor: 2.576
Authors: Alissa J Ellis; Larissa C Portnoff; David A Axelson; Robert A Kowatch; Patricia Walshaw; David J Miklowitz Journal: Psychiatry Res Date: 2014-02-18 Impact factor: 3.222
Authors: D G Kondo; T L Hellem; X-F Shi; Y H Sung; A P Prescot; T S Kim; R S Huber; L N Forrest; P F Renshaw Journal: AJNR Am J Neuroradiol Date: 2014-02-20 Impact factor: 3.825
Authors: Lisa A O'Donnell; Alissa J Ellis; Margaret M Van de Loo; Jonathan P Stange; David A Axelson; Robert A Kowatch; Christopher D Schneck; David J Miklowitz Journal: J Affect Disord Date: 2018-04-09 Impact factor: 4.839
Authors: Jay A Salpekar; Paramjit T Joshi; David A Axelson; Shauna P Reinblatt; Gayane Yenokyan; Abanti Sanyal; John T Walkup; Benedetto Vitiello; Joan L Luby; Karen Dineen Wagner; Nasima Nusrat; Mark A Riddle Journal: J Am Acad Child Adolesc Psychiatry Date: 2015-10-08 Impact factor: 8.829